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Journal of the American Dental... Aug 2023Corticosteroids are used to manage pain after surgical tooth extractions. The authors assessed the effect of corticosteroids on acute postoperative pain in patients... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Corticosteroids are used to manage pain after surgical tooth extractions. The authors assessed the effect of corticosteroids on acute postoperative pain in patients undergoing surgical tooth extractions of mandibular third molars.
TYPES OF STUDIES REVIEWED
The authors conducted a systematic review and meta-analysis. The authors searched the Epistemonikos database, including MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the US clinical trials registry (ClinicalTrials.gov) from inception until April 2023. Pairs of reviewers independently screened titles and abstracts, then full texts of trials were identified as potentially eligible. After duplicate data abstraction, the authors conducted random-effects meta-analyses. Risk of bias was assessed using Version 2 of the Cochrane Risk of Bias tool and certainty of the evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
Forty randomized controlled trials proved eligible. The evidence suggested that corticosteroids compared with a placebo provided a trivial reduction in pain intensity measured 6 hours (mean difference, 8.79 points lower; 95% CI, 14.8 to 2.77 points lower; low certainty) and 24 hours after surgical tooth extraction (mean difference, 8.89 points lower; 95% CI, 10.71 to 7.06 points lower; very low certainty). The authors found no important difference between corticosteroids and a placebo with regard to incidence of postoperative infection (risk difference, 0%; 95% CI, -1% to 1%; low certainty) and alveolar osteitis (risk difference, 0%; 95% CI, -3% to 4%; very low certainty).
PRACTICAL IMPLICATIONS
Low and very low certainty evidence suggests that there is a trivial difference regarding postoperative pain intensity and adverse effects of corticosteroids administered orally, submucosally, or intramuscularly compared with a placebo in patients undergoing third-molar extractions.
Topics: Humans; Molar, Third; Acute Pain; Adrenal Cortex Hormones; Dry Socket; Postoperative Complications; Pain, Postoperative
PubMed: 37500235
DOI: 10.1016/j.adaj.2023.04.018 -
Clinical Oral Investigations Aug 2023To investigate the histomorphometric changes occurring in alveolar ridge preservation (ARP) based on the use of different plasma concentrates (PCs) in randomized... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To investigate the histomorphometric changes occurring in alveolar ridge preservation (ARP) based on the use of different plasma concentrates (PCs) in randomized clinical trials (RCT). There is controversy whether the placement of PCs in ARP is effective in the formation of new bone.
MATERIALS AND METHODS
A systematic review search was conducted in PubMed, Scopus, Web of Science, and Cochrane Database to answer the PICO question: In patients undergoing tooth extraction followed by ARP, do PCs alone in the post-extraction socket in comparison with spontaneous healing improve new vital bone formation percentage in histomorphometric analysis after more than 10 weeks? The risk of bias was assessed and a meta-analysis was conducted.
RESULTS
Of 3809 results, 8 studies were considered suitable for inclusion. A total of 255 teeth were extracted in 250 patients. Regarding the PCs used, ARP was performed with platelet- and leukocyte-rich fibrin (L-PRF) in 120 sockets, and with pure platelet-rich plasma (P-PRP) in 31 sockets and 104 sockets were controlled. PCs improved new bone formation in ARP with respect to the spontaneous healing group (SMD = 1.77, 95%C.I. = 1.47-2.06, p-value < 000.1). There were no differences between the different PCs (L-PRF and P-PRP).
CONCLUSION
The results of this meta-analysis support the efficacy of the use of PCs in new bone formation in ARP. With respect to the different types of PCs studied, no differences were observed.
CLINICAL RELEVANCE
When planning implant surgery after tooth extraction, treatment with PCs should be considered for ARP. Any PC increases new bone formation compared to spontaneous healing.
Topics: Humans; Tooth Socket; Alveolar Process; Osteogenesis; Tooth; Platelet-Rich Plasma; Tooth Extraction; Fibrin; Alveolar Ridge Augmentation
PubMed: 37439800
DOI: 10.1007/s00784-023-05126-8 -
Journal of Oral and Maxillofacial... Aug 2023Bone grafting is fundamental in the treatment of cleft patients, and several grafting materials have been used for this purpose. The objective of this study is to... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Bone grafting is fundamental in the treatment of cleft patients, and several grafting materials have been used for this purpose. The objective of this study is to evaluate the effectiveness of autogenous bone graft from the chin in the reconstruction of cleft alveolus.
METHODS
Searches were performed in six databases (PubMed, Scopus, Cochrane, LILACS, Embase, and Google Scholar) by two researchers individually until July 2022. This study was registered in the International Prospective Register of Systematic Reviews (CRD42021267954) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The predictor variable is reconstruction technique, grouped into three levels: autogenous genial grafts, other endochondral autogenous grafts, and bio- or tissue-engineered materials. The outcome variables were alveolar cleft healing rate and bone height. The secondary variables were complications that included infections, necrosis, paresthesia, and dehiscence. Data analysis included the risk of bias and assessment of the certainty of evidence by the risk of bias in nonrandomized studies of interventions and grading of recommendations, assessment, development, and evaluation tools, respectively. The meta-analysis was performed with heterogeneity based on random effects of I and 95% confidence.
RESULTS
In the initial search, 4,833 articles were found, and 10 of them were included in this systematic review. The included studies were from six countries on three different continents, with a sample of 692 patients. It was observed that the chin bone graft (214 patients) when compared to the endochondral bone graft (386 patients) reduced by 0.42 [confidence interval 95% = 0.18, 0.95] times the prevalence of bone resorption (P = .040 and I = 70%) analyzed in radiographic images. Two studies evaluated the bone filling through computed tomography, and there was no statistically significant difference between the groups (P = .340, I = 0%). Only two studies had a low risk of bias.
CONCLUSION
Based on a low certainty of evidence, the chin autogenous bone graft proved to be similar to the endochondral graft in the reconstruction of the cleft alveolar; however, the limited number of studies with high heterogeneity and an uncertain risk of bias decreased the strength of the results found in this systematic review. New controlled primary studies should be carried out with the purpose of safely determining the effectiveness of chin bone grafts for the reconstruction of cleft alveolar.
Topics: Humans; Bone Transplantation; Chin; Surgery, Plastic; Cleft Palate; Algorithms
PubMed: 37182542
DOI: 10.1016/j.joms.2023.04.011 -
The Cleft Palate-craniofacial Journal :... Feb 2024Cleft lip and/or palate is the most commonly documented orofacial anomaly and may impact the status of health and disease of adjacent teeth along with their associated... (Meta-Analysis)
Meta-Analysis
Cleft lip and/or palate is the most commonly documented orofacial anomaly and may impact the status of health and disease of adjacent teeth along with their associated supporting structures. The authors performed a systematic review and meta-analysis to assess whether the presence of clefts altered the periodontal status of patients. The study was registered in PROSPERO (CRD42020210178). A systematic search of literature was performed utilizing unique search strings for PubMed, Scopus, and GoogleScholar as databases including gray literature from April 28, 2020 to October 3, 2020. Cross-sectional and longitudinal human studies published in the English language, providing information about periodontal disease and its association with cleft lip, alveolus, and palate. Periodontal outcome measures such as gingival index (GI), clinical attachment level (CAL), plaque index (PI), periodontal probing depth (PPD), and bleeding on probing (BOP) were utilized as the main outcome measures. Patients with clefts were predisposed to poorer periodontal outcomes. Subgroup analysis revealed compromised periodontal measures for clefts as compared to control sites without cleft which were statistically significant in terms of GI [ = 2.44, = .01], CAL [ = 2.52, = .01], PI [ = 2.76, = .006] and not statistically significant for PPD [ = 0.27, = .79] and BOP [ = 1.47, = .14]. Within the limitations of the review, the authors conclude that the presence of orofacial clefts may predispose to periodontal compromise when compared to normal controls. The GRADE rating was moderate.
Topics: Humans; Cleft Lip; Cleft Palate; Cross-Sectional Studies; Periodontal Diseases; Tooth
PubMed: 36130097
DOI: 10.1177/10556656221127549 -
The Journal of Prosthetic Dentistry Sep 2023Immediate implant placement provides a popular therapeutic option. However, compromised sockets may jeopardize the treatment outcome. (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
Immediate implant placement provides a popular therapeutic option. However, compromised sockets may jeopardize the treatment outcome.
PURPOSE
The purpose of this systematic review and meta-analysis was to investigate the treatment outcome in terms of the implant survival rate and success parameters of immediate implant placement in compromised extraction sockets.
MATERIAL AND METHODS
An electronic search was conducted in PubMed, Embase, Cochrane Library, and ISI Web of Science up to January 2021. Studies evaluating implant survival rate and main success parameters were included for a qualitative and quantitative analysis (risk ratio and mean difference).
RESULTS
In total, 43 studies with analysis of 4825 sockets were included. Compared with the noncompromised sockets, the compromised group showed no significant differences in implant survival rates (risk ratio=0.992; 95% confidence interval (CI)=0.979 to 1.005; P=.246). No significant statistical differences were found in marginal bone level at ≤12 months (mean difference [MD]=0.033; 95% CI=-0.012 to 0.078; P=.154) or esthetic parameters.
CONCLUSIONS
Immediate implant placement in compromised sites does not appear to decrease the survival and success rates. However, randomized clinical trials with large sample sizes should be conducted to draw a definite conclusion about the efficacy and safety of this treatment protocol in compromised sockets.
Topics: Dental Implantation, Endosseous; Dental Implants; Tooth Socket; Esthetics, Dental; Immediate Dental Implant Loading
PubMed: 34772483
DOI: 10.1016/j.prosdent.2021.09.025 -
The Journal of Prosthetic Dentistry Aug 2023As socket grafting with commercially available biomaterials has become popular, reports of the root submergence technique for ridge preservation have decreased. A...
STATEMENT OF PROBLEM
As socket grafting with commercially available biomaterials has become popular, reports of the root submergence technique for ridge preservation have decreased. A systematic review of this partial extraction therapy is lacking.
PURPOSE
The purpose of this systematic review was to review the root submergence technique as well as critically appraise the available data.
MATERIAL AND METHODS
A review was carried out that observed the Participant, Intervention, Comparison, Outcomes (PICO) strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The focused question was "What are the outcomes of the different methods to submerge tooth roots for ridge preservation?" Medical subject headings (MeSH) terms that related to the root submergence technique were searched in PubMed/MEDLINE, Scopus, and the Cochrane Library databases.
RESULTS
A total of 7709 abstracts and study titles were individually screened from the initial search results. After reviewing the full-text articles and applying the selection criteria, the final included search results totaled 47 full-text articles for in-depth review. In 10 animal studies, 258 roots were studied in 34 dogs and 7 monkeys. Histological data confirmed that coronal bridging (bone or cementum growth over the cut root) was a common outcome. Of the vital roots submerged, the majority maintained their vitality. In 37 human studies, 475 roots were submerged and reported on. Subjective ridge preservation was often reported. Among the adverse healing outcomes, exposure of the root through the mucosa was the most common. Nonetheless, in animals, 86.8% of roots remained submerged; in humans, 74.7%.
CONCLUSIONS
Root submergence is an established technique for ridge preservation. Exposure is a common complication, and correct technique may be key to its prevention. Further research of this partial extraction therapy is encouraged.
Topics: Animals; Dogs; Humans; Alveolar Process; Alveolar Ridge Augmentation; Biocompatible Materials; Tooth Extraction; Tooth Socket
PubMed: 34750013
DOI: 10.1016/j.prosdent.2021.08.009